Mild Cognitive Impairment may be prevented by better blood pressure control

February 19, 2019 By R. Bart Sangal MD

Mild Cognitive Impairment may be prevented by better blood pressure control

According to a recent study, mild cognitive impairment (MCI) may be prevented by better blood pressure control. High blood pressure, which is not well controlled, causes inflammation of the blood vessels in the brain as well as the rest of the body. The results can be seen as white matter change on an MRI of the brain. White matter in the brain mediates communication between nerve cells. Damage to white matter may lead to miscommunication or slowed communication.

Many patients are resistant to taking enough medicine to get
their blood pressure truly under control. They look at their blood pressure and
say, “I just had some coffee,” or “I just climbed the stairs,” or “I was trying
to get here on time.” Others will say, “It was fine at my other doctor’s
office.” I tell them, “Buy an automatic blood pressure instrument and take it
at home. Take it three times a day (morning, afternoon and evening) for a week.
That will tell you what your blood pressure really is.” I also advise them that
manual blood pressure readings may not be reliable as. Those readings depend on
the skill of the operator and how hurried the operator is.

The SPRINT MIND study published online in the Journal of the American Medical Association in January 2019 looked at the effect of more intensive blood pressure control. It compared patients whose systolic (upper) blood pressure was controlled to be below 120 mm Hg, as opposed to the standard of below 140 mm Hg. The patients whose blood pressure was controlled more intensively were not more likely to have dementia. However, they were 20% more likely to have MCI.

One of the commonest causes of MCI may be white matter damage in the brain

The commonest cause of dementia is probably Alzheimer’s disease, and I do not expect better blood pressure control to make a significant dent in Alzheimer’s. I believe one of the commonest causes of MCI may be brain injury related to white matter damage in the brain. The most likely culprit for that is high blood pressure. Therefore, controlling blood pressure better should reduce the risk of developing MCI. Other causes of white matter damage in the brain may be diabetes, increased inflammation in general, and sleep apnea.

Thus, one way to avoid MCI is to control your blood pressure
intensively. Keep the systolic BP under 120 mm Hg. An added benefit is that
this also decreases the risk of other cardiovascular events.